What is Tetanus?
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Tetanus disease is caused by Clostridium tetani (C. tetani), a gram-positive, anaerobic bacterium with the ability to develop into spores. Tetanus spores are found in soil, manure and the digestive tract of animals and humans. Additionally, tetanus has also been found in contaminated heroin and on skin surfaces.(1)
The tetanus bacterium, C. tetani, produces two exotoxins, tetanolysin and tetanospasmin. The exact function of tetanolysin is currently unknown, but it has been established that the exotoxin tetanospasmin is the neurotoxin responsible for the clinical symptoms of tetanus.(2)
Tetanus bacteria don't survive in the presence of oxygen, but they are quite resistant to most chemicals and even heat.(3) Puncture wounds, which don't bleed heavily and are protected by tissue and skin from direct exposure to oxygen, can be the perfect environment for tetanus bacteria to multiply and cause infection.(4)
When tetanus enters the body, tetanus spores can multiply in conditions of low oxygen, producing toxins that spread throughout the body. The incubation period of tetanus infection, from the moment of exposure to the onset of the first symptoms, varies from three days to three weeks.(5) Initial symptoms include jaw and neck muscle stiffness, headache, seizures, changes in heart rate and blood pressure, fever, and chills. Complications include fractures, vocal cord spasms, difficulty breathing, pulmonary embolism, pneumonia, hospital-acquired infections during treatment, and death.(6)
There are four recognized forms of tetanus. The most common form of tetanus is called generalized tetanus and is responsible for about 80% of cases. The initial sign of generalized tetanus is usually jaw muscle spasms, often called "lockjaw." Muscle spasms involving the extremities, neck, and trunk may also occur. Complications of generalized tetanus can include severe muscle spasms and neurological abnormalities, resulting in prolonged hospital stays and even death. Localized tetanus, a less common form of the disease, involves muscle spasms near a wound. While considered a mild form of the disease and often associated with people previously vaccinated against tetanus, it has the potential to progress to generalized tetanus. Cephalic tetanus, a rare but serious form of the disease, is associated with ear infections or head injuries. Cephalic tetanus typically presents as cranial nerve palsy and can progress to localized or even generalized tetanus. Neonatal tetanus, while almost non-existent in the United States, continues to pose a threat to infants born in developing countries. Neonatal tetanus occurs mainly when delivery takes place in unsanitary conditions and the umbilical cord becomes contaminated.(7) Symptoms typically develop within a week: Infants are irritable, have difficulty feeding, and may be stiff with spasms.(8)
Treatment of tetanus involves immediate hospitalization and the use of human tetanus immunoglobulin (TIG). Additional measures include wound management, medications to control muscle spasms, airway management, and antibiotics.(9) Complete recovery from tetanus disease can take several months.(10)
There are no laboratory findings to confirm tetanus, and the diagnosis is based on clinical symptoms. In addition, only about 30% of the wounds of patients diagnosed with tetanus test positive for the tetanus bacterium.(11)
Tetanus has been subject to mandatory reporting since 1955(12) and 2018 cases of tetanus were reported in the EU/EEA in 92(13), of which 48 confirmed.
References (click to open)
- CDC Tetanus - Clostridium tetani Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.
- CDC Tetanus – Pathogenesis Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.
- CDC Tetanus - Clinical Features Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.
- CDC Symptoms and Complications Feb. 28, 2019
- WHO tetanus Jan. 21, 2019
- Hinfey PB Tetanus – Background Medscape Jan 18, 2019
- CDC Tetanus For Clinicians – Treatment Feb. 28, 2019
- WHO Western Pacific Region Q & A - What are the symptoms of tetanus? 2019
- CDC Tetanus – Laboratory Diagnosis Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.
- ISS - Epidemiology of tetanus in Italy
- Tetanus - Annual Epidemiological Report for 2018
This article is summarized and translated by National Vaccine Information Center.